Coping without a spleen

Q-I lost my spleen and kidney in an automobile accident, and have been advised that I will need to take antibiotics (amoxycillin) for the rest of my life. I am worried about the long term effects of taking antibiotics in this way and would also like to know if there are any alternatives? TE, Tunbridge Wells....

A-The spleen is the seat of our immunity and, as such, is one of the most important organs in the body. Its functions include producing white blood cells (WBC), engulfing and destroying bacteria and cellular debris, and destroying worn out red blood cells and platelets. It also serves as a blood reservoir; during times of high demand, such as haemorrhage, the spleen can release its stored blood and prevent shock.

Once the spleen is injured, it is usually necessary to remove it because it is difficult to repair. The spleen is also removed in the medical treatment of certain diseases such as idiopathic thrombocytopenic purpura (ITP) and to determine the extent of Hodgkin's disease. Once your spleen is removed, there are several factors to consider.

Removal of the spleen is associated with an increased risk of infections, including Haemophilus influenzae type b (Hib) as well as meningococcal and Escherichia coli infection. In particular, there is a risk of fatal pneumococcal pneumonia 2.5 per cent of patients die of pneumococcal pneumonia within five years of spleen removal. Because of this, patients with splenectomies are often advised to have a pneumococcal vaccine (with revaccination every six years) as well as long term antibiotic treatment.

The vaccine may, in fact, be a reasonable preventative measure particularly in asplenic children, who have a 20-to 100 fold higher rate of pneumococcal infection compared with healthy children (Pediatrics, 2000; 106: 367-76). There appears to be little risk to asplenic individuals from the pneumococcal vaccine (N Engl J Med, 1977; 297: 897-900). Some practitioners also advocate that asplenic individuals have the Hib jab as well. (But if you are against vaccination of any variety, you may wish to investigate homoeopathic vaccinations instead.)

As for lifelong antibiotics, the medical literature is very limited. Because the immune status of a person without a spleen is so drastically altered, the knee jerk reaction of many medics is to use daily antibiotics prophylactically. Over the years, conventional medicine has done little to question the real value of these prophylactic antibiotics.

According to conventional wisdom, antibiotics are necessary to protect against sepsis (blood poisoning) caused by the pneumococcus bacterium. While rare, sepsis is serious. It can develop very quickly occasionally before the individual can receive medical help into overwhelming post splenectomy infection syndrome (OPSI), fatal in 50-70 per cent of cases (West J Med, 1992; 157: 440-3). There have even been reports of fatal sepsis developing decades after a splenectomy (Nihon Rinsho Meneki Gakkai Kaishi, 1997; 20: 184-90; Tidsskr Nor Laegeforen, 1994; 114: 2709-10), illustrating the need for lifelong vigilance once the spleen is removed. As you are also missing a kidney and sepsis can adversely affect the kidneys as well as other areas of the body, you will need to be particularly careful.

That said, sepsis has many causes, and it is thought that pneumococcus accounts for only around 50 per cent of all sepsis cases in asplenic patients (NC Med, 1985; 46: 570-1). In a study with 63 deaths among 184 patients who had splenectomies, only 18 died of sepsis and only four (22 per cent) of these had documented pneumococcal infection (BMJ, 1993; 307: 1408-9).

Penicillin can only protect against pneumococcal sepsis, and then only if the antibiotic regime is strictly complied with. The drug's efficacy is also dependent on the bacteria not being drug resistant. Unfortunately, there is increasing pneumococcal resistance to penicillin and reports of the failure of antibiotics to protect asplenic patients (BMJ, 1994; 308: 131-2).

Long term use of antibiotics can leave the body open to invasion by other potentially dangerous organisms. At least one case of meningitis was reportedly caused by a penicillin resistant strain of pneumococci in a patient on long term ampicillin (J Infect, 1993; 27: 277-9).

There have been no long term trials to prove the efficacy of daily antibiotic regimes and, indeed, most studies of the use of penicillin in asplenic individuals have been performed on children under age three who had sickle cell disease. While these studies have shown benefit, they may not be so easily extrapolated to other individuals.

In view of this and the relative rarity of pneumococcal sepsis, some recommend a more cautious approach, focused on awareness of the risk of sepsis as well as awareness of the early warning signs of the condition. Such an approach may also include having your doctor provide a course of antibiotics for you to keep at home for use at the earliest signs of infection (Infect Med, 1996; 13: 779-83).

You may also need to consider changing your lifestyle to maintain a healthy immune system. This would include a highly nutritious diet based on fresh foods while avoiding sugar, fat and alcohol, which can further suppress the immune system. You might also consider taking high potency multiple vitamin and minerals, extra vitamin C (1000-3000 mg daily) and perhaps a bovine (beef) spleen extract, particularly if you decide to forego the daily antibiotics.

In asplenic individuals, the increased risk of infection is mostly attributed to a deficiency of the hormone like factor known as tuftsin (BMJ, 1977; 2: 1574-6). Tuftsin is produced only in the spleen and is a key stimulator of the immune system. Individuals without spleens need an outside source of tuftsin such as spleen extracts.

As early as the 1930s, orally administered bovine spleen extracts were shown to possess physiological activity in increasing white blood cell counts in cases of extreme WBC deficiency, as well as being of some benefit in malaria and typhoid patients.

Like thymus extracts, pharmaceutical grade bovine spleen extracts are popular in Germany for treating infections and as an immune enhancer in cancer. Spleen tissue extracts may thus be beneficial in asplenic individuals.

Hydrolysed (predigested) products containing concentrated tuftsin and splenopentin are preferable to crude preparations. Such products have shown promise in animal tests (Arzneim Forsch, 1991; 41: 1281-5). According to naturopath Michael Murray, based on clinical research, a daily supplement should provide 50 mg of tuftsin and splenopentin, or roughly 375-750 mg of total spleen peptides (Am J Nat Med, 1995; 2: 6-7). No side effects or adverse reactions have been reported with the use of oral spleen preparations.